Hormone Labs with Candi Kinney, FNP-C

INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.  
 

Jennifer: Hi everyone! Thank you for taking time out of your day to listen in. Today I am talking with Candi Kinney. Candi is a board-certified family nurse practitioner with a background in family medicine, urgent care and pediatrics. She specializes in bio-identical hormone replacement therapy for both men and women, IV therapy and medically supervised weight loss.  Candi – thank you so much for joining me today!  

Candi: Thank you. I'm so excited.  

Jennifer: I am too! I mean, we got to meet at the aesthetic show. Gosh, when was that? Last month?  

Candi: Yeah, I think it was last month.  

 Jennifer: Man, it goes so fast. So, it was exciting it's always nice to be able to put a face to the name and know who you're talking to. So how did you get started and what made you specialize in the field that you're in today?  

Candi: So, I initially got started in the field I'm in because I was did some primary care and I did some urgent care in an urgent care. We kind of did a little bit of primary care, as well, but I just really, really did not like chronic care treatment. You know, I was just tired of treating people with chronic illnesses. That sounds bad. I was tired of meeting people where they were already sick. You know, by the time you get to that point, they need medicine, they need all of this care. And a lot of times I'll be honest, they're not very compliant, so it's so hard to fix them when they've already gotten to that point and I just was like you know this is just not, I'm just not passionate about this, and I was raised with a single mom and so I've always been a strong advocate for women and so that's just something that naturally led me into hormone replacement and then IV Therapy and things like that where I could catch these patients before they got sick and that's just where my passion is. 

Jennifer: Absolutely - just healing people. Making them better. 

Candi: Yeah, making them better so they don't need to be healed.  

Jennifer: Yes completely. IV Therapy, what exactly is that? What do you use IV Therapy for?  

Candi: So, IV therapy we use for so many things. We have, you know, cancer patients that we treat who get an amazing result from IV Therapy. We have patients who come in just you know, they've had like a viral illness or something like that, and they just start are feeling run down so they come in for that. We've got some patients that come in with actual vitamin deficiencies. There is just a number and a variety of patients that we treat, and they just feel so amazing after this and you know I'll be honest when I first started, I was surprised myself by how amazing they felt after an IV, you know, a vitamin IV. But it has been life changing for some of our patients. Jennifer: I've heard great things about it. I've never tried it personally, but I see them all over and I feel like it's just getting so big right now. So, it's really awesome. I mean, especially if it works that's really what matters. And then I know the other main treatment in your clinic is hormone therapy. So, you mentioned, your mom made you kind of want to get into that with the women's health. But what else did? And what benefits have you seen from hormone therapy in your practice?  

Candi: Well, let me give you a statistic. So, by the year 2025, there's going to be over one billion women in menopause throughout the world. So that's 12% of the world's population and symptoms that they have you know, things like hot flashes, night sweats, depression, decreased libido, fatigue, all of those symptoms create a decline in women's quality of life. And it's a decline in their productivity. So, when you say that we're talking, with that amount of people, the American association of retired persons in 2017-2018 said only one in five women in the United States complaining of symptoms received a referral to a menopause specialist. So, of the 60% of women who did seek out medical treatment, only 75 of them were left untreated at all.  

Jennifer: Wow. 

Candi: It's an outrageous thing that this many women are experiencing this, but they're not getting any treatment. You know, that's just women's hormones.  

Jennifer: Yeah, that's statistic blows my mind because there are so many options out there. I mean, even if they don't want to do hormone pellets, I mean, there's options outside of hormone pellets that I don't understand why people don't want to help.  

Candi: Yeah, absolutely. You know, and I think that, and I'm not pointing the finger, but primary care has really failed them. You know, they go in to see their doctors and their doctors like, oh, it's just part of aging, you know, but it's not. There are things that can help with that. So, it's just crazy to me that they don't get the help they need.  

Jennifer: Yes. And I hear it from people all the time and I mean, it's all about and I've said this multiple times now, it's all about finding a doctor who actually listens to you and wants to help you. I mean, you can go to a million doctors, you're not going to get along with all of them just find someone who actually listens to you and cares about helping you because you're not supposed to live and be miserable.  

Candi: Absolutely, Absolutely.   

Jennifer: Okay, well, let's talk about hormone labs, because I know there's so many differences in lab work. So, what are the differences between saliva, blood, and urine tests.  

Candi: So, there's a few differences. In my clinic I just use blood. I initially started out with some saliva testing, but I just found that it didn't really give me much of a bigger picture that made me change my treatment. So, I have just stuck with blood. Blood tests are probably the most common test for hormone replacement and it's a great place to start. Even if you do the others, it's a great place to start for baseline levels. The blood is collected in the office and sent to the lab though the blood test tests for hormone levels present in the liquid part of the blood, known as the plasma, or the serum. So, this can tell you, you know, tells your provider whether you have excess or deficiency in your hormone levels. The great thing about blood testing is that you can test for multiple deficiencies at once. 

So, not only are you testing for like the sex hormones, which you can include FSH a1c, you know, thyroid, so many more things than just the sex hormones, which is, you know, estrogen testosterone and progesterone. The downside of blood testing, or the reason why some providers prefer other methods is that blood testing kind of gives you a snapshot it takes, you know what's happening in your blood at that time. So, it doesn't differentiate between what's free hormones, what's bound up hormones. So, it doesn't tell you, you know what's available at that moment. 

Jennifer: Just a question on that with the blood because you kind of said it's a snapshot. So, is there a better time to do a blood test? Like is in the morning better than?  

Candi: So, with females, it doesn't really matter. You're going to kind of get the same snapshot, no matter what time you take it with males, when we have males come in for blood test, we always have them come in in the morning. The guidelines say if you're going to test a male for testosterone, you want to test them early in the morning that's when they should, you know peak. So, we have a male come in the morning, but females, they don't have to come in in any certain time. Okay, so that's blood testing. So then with saliva - saliva test is a little different. So, all hormones circulate in the bloodstream, and they're bound by carrier proteins. So, saliva test show the bio available or the free hormone levels, versus the amount, you know, that's caught in your bloodstream. Patients are usually sent home with like a little test tube that they spit in. They collect the saliva at home, and they usually just mail it directly to the lab. So, you test the saliva  over a period of hours. So, like 12 hours or 24 hours. The reason that some providers like that better is because it gives more of a big picture, instead of the snapshot that you get from blood testing. The problem with saliva though is your depending on the patients to do it. And so, you know, there's a lot of really strict guidelines that they have to follow. You know, they have restrictions around eating and drinking and lipstick and chewing gum and brushing their teeth. So, you're depending on them to follow all those guidelines and then send the saliva in.  

Jennifer: Yeah, that's a lot of factors.  

Candi: Yeah. Saliva also isn't as accurate with topical or oral hormones. So, if you're taking them orally or using a topical solution, they're not as accurate either.  

Jennifer: Oh interesting.  

Candi: Yeah. And then the last one that you asked about is the urine test. So, the urine test is what's called the dutch test. That's kind of the newest one that people are doing. The dutch test, the newest dutch test is a lot better than the older one. The older one used to have to collect urine like all day long and keep it in the jug and then send those jugs in and it was just, it wasn't that great. But the newer dutch tests are really good. You just soak a pad in urine and then you let it dry and then you send that into the lab where the dutch test shines over the other one is that it measures the hormone metabolites. So, this tells your provider how you're breaking down the hormones. Unfortunately, it's really expensive. So, it's again not comprehensive like the blood. So, you're still only getting the sex hormones. It just depends, your provider, whatever provider you go to, you'll get whatever lab they like to do you.   

Jennifer: Are there insurances that cover the lab test or is it all out of pocket?  

Candi: I mean blood tests for sure is always covered by insurance. 

Jennifer: Oh, is it? 

Candi: Yeah. Yeah. Blood test is always covered by insurance. Even though we don't take insurance in our practice, our lab bills their insurance. So that's always covered. The two I don't think that those are covered, they’re out of pocket and they're both more expensive, which is you know another factor when you're considering doing labs.  

Jennifer: Yeah. Absolutely. So, what blood work panels do you require to have done and what do they entail? 

Candi: So, on all of my patients, male and female, I check thyroid panel which is a TSH (thyroid stimulating hormone), a free T3 (Triiodothyronine), a TPO (thyroid peroxidase) Antibody, to see if they have any thyroid issues. You know they're PCP is usually only checking their TSH, but that's not a great picture of what's going on with their thyroid. You always want to check a free T3, which tells the active amount of thyroid that they have which is the thyroid that makes you feel the best.Then you always want to check a TPO antibody to see if they have anything like hashimoto's, which is an auto immune disorder, and your primary care doctor is not checking for those. Then I check an estradiol, a free and total testosterone and SHBG (sex hormone binding globulin), free testosterone is your active testosterone, total testosterone is just how much you have total. The active is what makes you feel the best - it's what does all the work. And then an SHBG a sex hormone binding globulin and what that does is it binds up the sex hormones. So, you want to see if your SHBG is high, then you know why your testosterone, your estrogen are not circulating the way that they should. The other one I check is vitamin D. I check vitamin D on everyone. Everyone has, almost 90% of the patients that I check vitamin D level on - it's terrible. It's amazing how many people have low vitamin D levels. So, we check vitamin D level on everyone, male and female. I always tell people vitamin D is a vitamin but it's also a pre hormone. So, if we fix your hormone levels but your vitamin D is in the tank it's kind of like we put gas in the tank but we're not pushing the pedal. So, we always check vitamin D level on everyone.  

Jennifer: That's very interesting.  

Candi: Yeah - I think vitamin D got much more put out there for everyone when covid hit. I've heard from everyone your vitamin. D levels need to be high, but vitamin D levels are important for so many things. I mean, so we definitely always check vitamin D level on everyone. And then if they don't have a PCP or they haven't had any recent lab work, then of course we'll check like a CBC (complete blood count), CMP (comprehensive metabolic panel) and a lipid panel, which is just, you know, your regular panel that your doctor normally orders for you  

Jennifer: When you, because you were talking about the differences between the free testosterone and the total testosterone, when you do the hormone replacement with testosterone, does that testosterone fall into one or both categories? 

Candi: So, both. So with males especially. So, when I'm looking to treat, I'm looking at both your free and your total. When we increase your total, your free is going to come up. But a lot of times we'll see like a quote “normal” total, but your free is low. So, that tells me that, you know, your symptoms are still coming from an abnormal testosterone level. So, we check a free, just kind of as a backup to the total. You know, to say, okay, yeah, your free is normal, but your totals in the tank - no wonder you're feeling bad.  

Jennifer: Which my next question was, how do you measure the lab results to know what an individual needs?   

Candi: Well, the thing is is that I don't give a lot of weight to lab values. So, when we're talking about how to treat a patient, I'm not going to go by just what the values are. You know, if I look at your thyroid panel and it's high or it's low and you come in and you know, if you go to a regular doctor, they're going to be like, “oh, miss Smith, your levels are fine”, but the thing is Miss Smith doesn't feel fine, she feels terrible. You know, she has all the symptoms of hypothyroidism, but yet her levels are quote “within normal limits”. If you go by just the levels, you're never going to treat, you're not going to treat half these patients, you know? So, I don't go by the levels - I use the levels as a guideline, kind of just, you know, give me that snapshot of where they are, and then I base my treatment on symptoms, you know, 100%. There's just, you know, like I said, I use the labs as a guideline, but I go by their symptoms. 

Jennifer: Yeah, that makes so much sense because, like you said, the normal levels for one person, that's going to be completely different than – or not normal, I should say, but optimal levels are going to be totally different per individual and what their individual body needs. So how can you just put a direct number for one thing?  

Candi: Yes, absolutely.  

Jennifer: Well, I think that kind of covers at all. Is there anything additional you would like to add about hormones or hormone labs?  

Candi: I think that you said something that it's really funny that you said that because I talk to my patients about it all the time. I give them what I call my death talk. So, what I tell them when they come in, I tell all my patients and they come to see me for hormones. I tell them, you know, part of aging, you know, we're all aging, we're all getting older and part of getting older is we're heading towards death. You know, part of that is losing your hormones. I tell people you're not losing your hormone levels because you're aging, you're aging because you're losing your hormone levels and that's part of life. You know, that's part of getting older and dying. You lose your hormones. But there's a lot of things that are part of aging that we combat, you know, osteoporosis is part of aging, but we still give patients medicine for that. So, if we have something that can help you feel the best that you can feel, why wouldn't you? You know, I mean, I have seen my patients, their lives have been changed by hormone replacement. I had one guy, he was in his twenties, he came in, his marriage was falling apart, he was depressed, he was just like his life was in a shambles and he said, “I need my hormone levels checked”, and of course we checked him. His testosterone was 107.  

Jennifer: Oh my gosh.  

Candi: And he was in his late twenties. So, he was just, his life was just a mess. We started him on hormone replacement. He came back in a month, and he was a different person.  

Jennifer: Oh my gosh, that's amazing.  

Candi: His marriage was better, his sex life of course was better, but he felt better like his depression - everything. So, when people think about hormones, they always just go straight to libido, but it's so much more than libido. It's your quality of life, it's your marriage, it's your attitude. It's everything. So no, you don't have to replace your hormones, but why wouldn't you if you feel so much better.  

Jennifer: Absolutely - whatever you said about the aging and hormones. That statement, you told us that at the aesthetic show and after you walked off, we were trying to repeat it. We were like that's so good. But we could not think of what it was. We tried for so long to think about what it was. But I mean, it's so true though. I mean aging you're going to age but why not feel better while you age if you can?  

Candi: Absolutely, absolutely.  

Jennifer: well, thank you again for joining me for more information on Candi please visit definitewellness.net or you can find her practice on Facebook at Definite Wellness and thank you everyone for listening. Please make sure to subscribe and follow us on social media to stay up to date on Qualgen. Thank you again, Candi!  

Candi: You're welcome. Thank you for having me. 

Jennifer: Absolutely. Any time! 

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